Differential Effects of Early Weaning for HIV-Free Survival of Children Born to HIV-Infected Mothers by Severity of Maternal Disease

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dc.contributor.author Kuhn, Louise en_US
dc.contributor.author Aldrovandi, Grace M. en_US
dc.contributor.author Sinkala, Moses en_US
dc.contributor.author Kankasa, Chipepo en_US
dc.contributor.author Semrau, Katherine en_US
dc.contributor.author Kasonde, Prisca en_US
dc.contributor.author Mwiya, Mwiya en_US
dc.contributor.author Tsai, Wei-Yann en_US
dc.contributor.author Thea, Donald M. en_US
dc.date.accessioned 2012-01-11T21:43:54Z
dc.date.available 2012-01-11T21:43:54Z
dc.date.issued 2009-6-26 en_US
dc.identifier.citation Kuhn, Louise, Grace M. Aldrovandi, Moses Sinkala, Chipepo Kankasa, Katherine Semrau, Prisca Kasonde, Mwiya Mwiya, Wei-Yann Tsai, Donald M. Thea. "Differential Effects of Early Weaning for HIV-Free Survival of Children Born to HIV-Infected Mothers by Severity of Maternal Disease" PLoS ONE 4(6): e6059. (2009) en_US
dc.identifier.issn 1932-6203 en_US
dc.identifier.uri http://hdl.handle.net/2144/3249
dc.description.abstract BACKGROUND. We previously reported no benefit of early weaning for HIV-free survival of children born to HIV-infected mothers in intent-to-treat analyses. Since early weaning was poorly accepted, we conducted a secondary analysis to investigate whether beneficial effects may have been hidden. METHODS. 958 HIV-infected women in Lusaka, Zambia, were randomized to abrupt weaning at 4 months (intervention) or to continued breastfeeding (control). Children were followed to 24 months with regular HIV PCR tests and examinations to determine HIV infection or death. Detailed behavioral data were collected on when all breastfeeding ended. Most participants were recruited before antiretroviral treatment (ART) became available. We compared outcomes among mother-child pairs who weaned earlier or later than intended by study design adjusting for potential confounders. RESULTS. Of infants alive, uninfected and still breastfeeding at 4 months in the intervention group, 16.1% who weaned as instructed acquired HIV or died by 24 months compared to 16.0% who did not comply (p=0.98). Children of women with less severe disease during pregnancy (not eligible for ART) had worse outcomes if their mothers weaned as instructed (RH=2.60 95% CI: 1.06-6.36) compared to those who continued breastfeeding. Conversely, children of mothers with more severe disease (eligible for ART but did not receive it) who weaned early had better outcomes (p-value interaction=0.002). In the control group, weaning before 15 months was associated with 3.94-fold (95% CI: 1.65-9.39) increase in HIV infection or death among infants of mothers with less severe disease. CONCLUSION. Incomplete adherence did not mask a benefit of early weaning. On the contrary, for women with less severe disease, early weaning was harmful and continued breastfeeding resulted in better outcomes. For women with more advanced disease, ART should be given during pregnancy for maternal health and to reduce transmission, including through breastfeeding. TRIAL REGISTRATION. Clinical trials.gov NCT00310726 en_US
dc.description.sponsorship National Institute of Child Health and Human Development (NICHD); National Institutes of Health (R01 HD 39611, R01 HD 40777) en_US
dc.language.iso en en_US
dc.publisher Public Library of Science en_US
dc.rights Kuhn et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_US
dc.title Differential Effects of Early Weaning for HIV-Free Survival of Children Born to HIV-Infected Mothers by Severity of Maternal Disease en_US
dc.type article en_US
dc.identifier.doi 10.1371/journal.pone.0006059 en_US
dc.identifier.pubmedid 19557167 en_US
dc.identifier.pmcid 2698120 en_US

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